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(영문) 서울행정법원 2018.10.18 2017구합75941
요양급여비용환수결정처분취소 청구의 소
Text

1. The Defendant’s disposition to recover medical care benefit costs of KRW 20,294,430, which the Plaintiff rendered on June 1, 2017, shall be revoked.

2...

Reasons

1. Details of the disposition;

A. On August 7, 2006, the Plaintiff, as a doctor, opened a C Hospital, which is a health care institution under the National Health Insurance Act (hereinafter “instant hospital”), in Eunpyeong-gu Seoul. On April 15, 2015, the Plaintiff extended and operated the hospital to D in Eunpyeong-gu Seoul.

B. The Minister of Health and Welfare, around June 2016, conducted on-site inspections with respect to the instant hospital (hereinafter “on-site inspections”) and from April 17, 2017 to April 21, 2017, respectively, on-site inspections (the period subject to investigation: February 2014 to November 2016 and January 2017; hereinafter “on-site inspections”) and determined that the Plaintiff received the costs of health care benefit of KRW 20,294,430 as follows.

A request for calculation of differential rates of nursing care fees for inpatientss - The following shall be made to a nurse exclusively in charge of providing emergency nursing services, such as the examination room, operation room, and emergency service, and the fact that he/she unfairly claims the rating of nursing care fees for general sick and nursing services on a yearly basis (hereinafter referred to as the "grounds for the instant disposition") (hereinafter referred to as the "grounds for the disposition") from the end of May 201 to the actual service of the reported sick and nursing department (general sick and sick) on a non-regular basis at the end of May 2010, as follows:

C. On May 11, 2017, the Defendant notified the Plaintiff of the decision to recover medical care benefit costs of KRW 20,294,430, based on Article 57(1) of the National Health Insurance Act, on June 1, 2017.

(hereinafter referred to as the "disposition of this case"). Criteria for calculation of differential rate of nursing care fees for inpatients.

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